Each year in the U.S., six million people, roughly the population of Massachusetts, get peptic ulcer disease, most of which is caused by infection with a specific bacteria, H. pylori.
But in recent years, far fewer of them have required hospitalization. According to an article in the Wednesday's issue of the journal Emerging Infectious Diseases published by the Centers for Disease Control and Prevention, the age-adjusted rate of hospitalization for patients diagnosed with peptic ulcer disease decreased by 21% (from 71.1 per 100,000 population to 56.5) between 1998 and 2005.
The decline was subsequent to the 1997 launch of an educational campaign by federal agencies, academic medical institutions and private industry to promote use antimicrobial drugs on the bacteria.
Researchers realized in 1983 that peptic ulcer disease was caused by a bacteria and could be effectively treated with drugs without hospitalization. And though hospitalizations to treat bleeding and perforations declined somewhat they remained unacceptably high, apparently because providers and patients were poorly educated about its simple cause, according to a 1995 CDC report.
Practitioners remained skeptical or unaware that a bug was the issue. "One reason was the lack of knowledge among the general public and clinicians about the link," says the current article.
CDC researchers, however, say variations in peptic ulcer hospitalizations across the country remain a concern, indicating that not all providers have universally picked up the message.
Among the reports in the recent report:
- Hospitalization rates were higher in southern states, than in western, and northeastern regions.
- Hospitalization rates were significantly higher for male patients than for females, 71.9 per 100,000 compared with 56.3, in all age groups and race/ethnicity groups, although this gap narrowed over the eight-year study period.
- Rates were lower for whites, 44.2 per 100,000 than for other racial ethnic groups.
- Rates between 1998 and 2005 declined for all age groups except children and adolescents under age 20, for whom there was no change.
- The highest rates of hospitalizations for both peptic ulcer disease and H. pylori infection were for adults age 65 and older and decreased with each subsequent age group. That may have been linked to what the authors call a "birth cohort effect," a decrease in H. pylori in younger generations "because of improved sanitation and fewer risk factors for transmission."
Researchers said there is a possibility that some of the decline may be due to reduced use of non-steroidal anti-inflammatory drug use, proton pump inhibitors, and possible undercoding of H. pylori in hospital discharge records, and suggests further studies to illuminate these trends.
But, they added, "To facilitate further declines in hospitalizations for peptic ulcer disease, patients and clinicians should continue to be educated about the association between H. pylori and peptic ulcer disease."
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